Credentialling Coordinator

Company: Innova Solutions
Location: New York
Posted on: May 28, 2023

Job Description:

Our client, an insurance provider, is searching for a Credentialling Coordinator. This is a contract role, where employees are required to be onsite 5 days per week. The full job description is as follows:Location: NYCJob Type: 6+ months renewable contractPosition OverviewOur client is seeking an individual to join our Credentialing Department in the capacity of Credentialing Coordinator. This position is be responsible for credentialing of new providers including Behavioral Health providers & facilities, re-credentialing, and processing provider demographic updates and changes. The Credentialing Coordinator is responsible for document collection, review, verification, and provider credentialing file maintenance. This position also ensures that all credentialing supporting documentation is confidential and maintained in a secure environment. Lastly, the Credentialing Coordinator assists facilities and providers in understanding and adhering to their policies and procedures regarding the credentialing process/provider information updateScope of Role & ResponsibilitiesMaintain communication with the credentialing contacts at facilities and provider sites to coordinate receipt of information required for credentialing, re-credentialing, and update of provider credentialing informationReview provider re-credentialing and credentialing file for completion and presentation to the Credentialing Committee.Perform primary source verification on required elements and in accordance regulatory guidelines and policies and proceduresData entry and upkeep of provider information in the credentialing and other pertinent databasesVerify New York State OPMC, Medicare/Medicaid lists and other pertinent databases for any currentsanctions, restrictions on licensure and/or limitations on the scope of practice on all credentialed providers in interim credentialing periodsVerify New York State license registration and DEA registration status for all credentialed providers in the interim credentialing periodsGenerate and disseminate monthly provider credentialing updates to appropriate departments atour office's and participating facilities and provider groupsReview and respond to request for credentialing information/copies of credentialing files to appropriate departments within the organization.Generate and disseminate provider rosters to delegated facilities, contracted group practices etc.Perform provider roster reconciliationCreate, copy, file, and maintain all relevant documentation into provider credentialing folder.Maintain confidentiality of provider credentials by filing the credentialing folder in respective cabinets in the file rooms.Perform annual delegated file audits and participate in pre-delegation and delegation site reviewsRespond to inquiries from other departments relative to a provider's credentialing statusPerforms other related tasks as directed by the Deputy Chief Operating Officer or her designee, the Credentialing Director or Credentialing Team LeadRequired Education, Training & Professional ExperienceHighschool Degree required; Bachelor's Degree preferredPrevious experience with provider credentialing processes and proceduresKnowledge of CACTUS preferredMust be able to handle multiple projects simultaneously.Comprehensive knowledge of managed care with a specific emphasis on physician credentialing.Ability to meet time-sensitive deadlines and multi-task in a changing healthcare environment.Understanding of credentialing activities as they relate to initial credentialing, re-credentialing, andcredentials modification(s).PDN-99091335-04a3-4fcb-8e86-5593348d51da

Keywords: Innova Solutions, New York , Credentialling Coordinator, Other , New York, New York